Post-pregnancy

Family planning is a personal choice. It should be initiated after the various options available have been discussed by the couple and agreed upon. These can vary from male/female condoms, pills, injections, intrauterine devices and implants, or permanent contraception such as vasectomy and tubal ligation (typing up the tubes). This is particularly important if the couple is not planning on trying for a baby in the immediate term.

The best way to prevent an unplanned pregnancy soon after giving birth is by using an effective method of contraception. Before a woman decides on which contraceptive method she is going to use, it is important to understand the following:

• How the method works
• How reliable the method is
• How reliable the method is
• When it will start to work

A woman can start using contraceptives immediately after giving birth, especially if she does not intend to breastfeed. If she is not breastfeeding, a wider variety of contraception options are available to her. The options for breastfeeding moms are limited to those containing progesterone or non-hormonal barrier contraceptives such as condoms, diaphragms, and cervical caps.

Breastfeeding, when used as a contraceptive method, is known as lactational amenorrhoea. It can be up to 98% effective in preventing pregnancy if all of the following conditions apply:

• The mother breastfeeds exclusively, meaning she is not giving her baby any other liquid or solid food
• The mother breastfeeds almost exclusively, meaning she is mainly breastfeeding her baby and infrequently giving her baby other liquids
• The baby is younger than six months
• The mother has no periods

The risk of pregnancy increases if:

• The mother starts breastfeeding less often
• There are long intervals between feeds, both during the day and night
• The mother stops night feeds and uses supplemental feeding instead
• Once the baby is older than six months, the mother's risk of getting pregnant increases. Even if the mother does not have periods and is fully or nearly breastfeeding, she should use another contraceptive method.

Hormonal contraceptives containing oestrogen can adversely affect your milk supply and, therefore, should not be used during breastfeeding. Progesterone-only pills are less likely to decrease milk supply. It is recommended to start with a lower-dosage form such as progesterone pills rather than higher-dose progesterone injectables. These injectables last two to three months and cannot be reversed once given. If there are no problems with your milk supply after using progesterone-only pills, you can have the injection if desired. Hormonal contraceptives will not affect the baby.

In addition to preventing pregnancy, the general benefits of using contraceptives may also apply after birth, though to a lesser degree. Some include:

• Regular or lighter monthly periods
• Improved acne or facial hair growth
• Easing of menstrual migraines
• Reduced risk of ovarian cancer (potentially) if used for more than five years
• Apart from limiting milk production, the risks may include reduction in libido, risk of developing blood clots, breakthrough bleeding (irregular periods) and mood changes

Weight gain is commonly cited as a side effect of hormonal contraception. There is general agreement that the use of combined (oestrogen and progesterone) contraceptives does not lead to weight gain and that progesterone-only methods (like Depo-Provera) seem to be the cause of some weight gain. This is especially so in younger adolescents compared to older women.

Most contraceptive methods have their onset of action almost immediately after initiation. If monthly periods have already begun and the contraceptive pill is being used, the following guideline applies: if the pill is started on day one of bleeding, then it is effective immediately. If started on day five, then it will be effective in 14 days – any other starting point is not safe until the start of the second packet of the pill.

Reflux is a condition in which the muscle between the oesophagus and the stomach relaxes to let stomach acid back up into the oesophagus. This results in a type of vomiting or spitting called 'posseting'. While reflux is normal and often just the result of a baby's underdeveloped oesophagus (food canal), it can be very frustrating for parents. Most babies will outgrow reflux, with symptoms stopping when the baby reaches 12 to 14 months of age. This is around the same time that the ring of muscle at the bottom of their oesophagus fully develops and closes off, preventing stomach contents from leaking out. It is unusual for reflux to continue after 18 months.

There are a few ways of easing reflux, and these include:

• Burping your baby regularly throughout the feeding
• Avoiding overfeeding and rather feeding little and often
• Checking that the hole in your baby's teat is not too big
• Holding your baby upright for a period of time after feeding and raising the head end of your child's cot or crib for sleep time.

If these methods do not work, it is best to see a paediatrician who will be able to determine the best treatment.

Not every baby who vomits has reflux. Sometimes vomiting can be caused by another medical problem ranging from a bacterial or viral infection to a cow's milk allergy, an intestinal blockage, or a head injury. Repeated projectile vomiting that begins around three to five weeks may be due to a thickening of the muscle where the stomach empties into the small intestine. This condition – known as pyloric stenosis – requires immediate medical attention and minor surgery. Vomiting may also be a result of gastro-oesophageal reflux disease (GORD), a more serious long-term form of reflux. It is estimated that 65 to 85% of premature babies suffer from GORD. The symptoms include pain and discomfort in the chest or upper abdomen, which might make your baby cranky. Your baby might cry a lot or arch his back. If your baby has GORD, her sleep might be disrupted sometimes, or she might show poor weight gain. You should also lookout for a chronic cough and wheeze. GORD can be treated with medication.